Deceased
Robert Michael Humphreys
Demographics
71y, male
Coroner
Coroner Peter White
Date of death
2015-09-07
Finding date
2018-11-19
Cause of death
Aspiration in setting of paralytic ileus in patient in convalescent phase of abdominal aortic aneurysm repair
AI-generated summary
A 71-year-old man died from aspiration complicating prolonged paralytic ileus on postoperative day 9 following open abdominal aortic aneurysm repair. Despite clinical signs of persistent ileus (vomiting, abdominal distension, abnormal bowel movements), the surgeon Dr C. did not reinstate bowel rest, nasogastric tube, or radiological imaging. He declined a medical registrar review when contacted on day 8 evening despite family concerns about deterioration. The coroner found the postoperative management suboptimal. Radiological examination on day 5-7 would have revealed ongoing ileus, warranting nasogastric tube reinsertion and bowel rest, which would have likely prevented aspiration. Key clinical lessons: maintain vigilance for evolving paralytic ileus despite signs of bowel recovery; reassess regularly with imaging when signs persist; involve senior review and multidisciplinary input for complex post-operative cases; document clinical observations thoroughly.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.
Specialties
Error types
Drugs involved
Clinical conditions
Procedures
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A 40-year-old man with obesity, COPD, diabetes and hypertension died from acute hepatic and renal failure following postoperative haemorrhage after left radical nephrectomy for a 10cm renal cell carcinoma. The surgeon ap…
75y · Male·ruptured abdominal aortic aneurysm
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